IPC和低分子肝素对亚洲胃肠恶性肿瘤患者术后静脉血栓栓塞症预防效果的Meta分析  

Meta-analysis of the preventive effects of IPC and low molecular weight heparin on postoperative VTE in Asian patients with gastrointestinal malignancies

作　　者：龙泉河 许雅洁 毛伟征[1] LONG Quan-he;XU Ya-jie;MAO Wei-zheng(Department of General Surgery,Qingdao Municipal Hospital,Qingdao Clinical Medical College,Nanjing Medical University,Qingdao 266000,China;Department of Gastroenterology,Qingdao Municipal Hospital,Qingdao Clinical Medical College,Nanjing Medical University,Qingdao 266000,China)

机构地区：[1]南京医科大学附属青岛临床医学院青岛市市立医院普外科,山东青岛266000 [2]南京医科大学附属青岛临床医学院青岛市市立医院消化内科,山东青岛266000

出　　处：《中国现代普通外科进展》2022年第8期618-624,共7页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:评价间歇性充气加压装置(IPC)和低分子肝素(LMWH)在亚洲胃肠道恶性肿瘤患者术后预防静脉血栓栓塞症(VTE)的安全性和有效性。方法:计算机检索中国知网(CNKI)、万方数据库、维普数据库、Sinomed数据库、Cochrane Library、Embase及Pub Med数据库关于比较亚洲胃肠道恶性肿瘤患者术后给予IPC、IPC联合LMWH预防VTE效果的随机对照试验(RCT)。检索日期为数据库建库至2020年12月。纳入符合标准的相关文献,并提取数据,采用Rev Man 5.3.0软件进行Meta分析。结果:共有5项RCT结果1821例患者数据纳入研究,其中IPC组为936例,IPC+LMWH组885例。Meta分析结果显示:与单纯IPC比较,IPC联合LMWH明显降低VTE发病风险(RR=0.48,95%CI:0.28~0.82,P=0.007),DVT和PE发病率明显减少(RR=0.55,95%CI:0.31~0.97,P=0.04;RR=0.23,95%CI:0.07~0.81,P=0.02);出血事件发生率(RR=0.23,95%CI:0.07~0.81,P<0.00001)和大出血事件发生率均增加(RR=5.03,95%CI:2.17~11.65,P=0.0002);肝功能影响更大(RR=3.57,95%CI:1.84~6.90,P=0.0002)。两组吻合口漏、术后肠梗阻、伤口感染等并发症发生率比较差异无统计学意义(P>0.05)。结论:IPC联合LMWH预防亚洲胃肠恶性肿瘤患者术后VTE效果较好,但出血等相关并发症发生率较单纯IPC高,应用前应行出血风险评估。Objective:To evaluate the safety and efficacy of intermittent pneumatic compression and low molecular weight heparin in the prevention of VTE in postoperative patients with gastrointestinal malignant tumors.Methods:Randomized controlled trials(RCTs)comparing the effect of postoperative IPC and IPC combined with LMWH on the prevention of VTE in patients with gastrointestinal cancer were searched from CNKI,Wanfang database,VIP database,Sinomed database,Cochranelibrary,Embase and Pub Med database.The retrieval date is from the establishment of the database to December 2020.Relevant literatures that met the criteria were included,and data were extracted for Meta-analysis using Rev Man5.3.0 software.Results:A total of 5 RCT results were included in the study,and data were collected from 1821 patients,including IPC group(n=936)and IPC+LMWH group(n=885).The results of Meta analysis showed that postoperative use of IPC combined with LMWH in patients with gastrointestinal malignant tumors significantly reduced the incidence of VTE compared with IPC alone(RR=0.48,95%CI:0.28-0.82,P=0.007).The incidence of DVT and PE also decreased significantly(RR=0.55,95%CI:0.31-0.97,P=0.04;RR=0.23,95%CI:0.07-0.81,P=0.02).However,the incidence of bleeding complications of IPC combined with LMWH is higher(RR=0.23,95%CI:0.07-0.81,P<0.00001).The incidence of major bleeding was also higher than that in the IPC group(RR=5.03,95%CI:2.17-11.65,P=0.0002)And it has an effect on liver function(RR=3.57,95%CI:1.84-6.90,P=0.0002).There was no significant difference in the incidence of anastomotic leakage,postoperative intestinal obstruction and wound infection between the two groups(P>0.05).Conclusion:IPC combined with LMWH is effective in preventing VTE after surgery in Asian patients with gastrointestinal malignancies,but the incidence of bleeding-related complications is higher than that of IPC alone.Bleeding risk assessment should be performed before application.

关 键 词：静脉血栓栓塞症 胃肿瘤 肠道肿瘤 术后并发症 亚洲 META分析 

分 类 号：R543.6[医药卫生—心血管疾病]